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147 Using an implementation strategy to improve guideline-adherent delirium care in hospices: Emerging findings of the DAMPen-Delirium feasibility study
  1. Gillian Jackson1,
  2. Catriona Jackson2,
  3. Jason Boland1,
  4. Imogen Featherstone3,
  5. Chao Huang1,
  6. Margaret Ogden4,
  7. Kathryn Sartain1,5,
  8. Najma Siddiqi6,
  9. Maureen Twiddy1,
  10. Miriam Johnson1 and
  11. Mark Pearson1
  1. 1Hull York Medical School, University of Hull, UK
  2. 2St James’s University Hospital, Leeds, UK
  3. 3Department of Health Sciences, University of York, UK
  4. 4Faculty of Social Sciences, University of Stirling, UK
  5. 5York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
  6. 6Department of Psychiatry, University of York, UK


Background Delirium is a complex condition, distressing for patients, family members and staff, and associated with poor outcomes. Despite high prevalence in the palliative care setting, it remains under-diagnosed. Delirium guideline-adherent care may both prevent and alleviate delirium. The best way to improve delirium-guideline adherence, and whether better adherence is reflected in reduced delirium, is not known. Prompt dissemination of feasibility findings is critical to avoid research waste.

Methods To inform a definitive large study, working closely with Patient Public Involvement members, we conducted a co-design and feasibility study (ISRCTN55416525) to assess the feasibility of collecting data (delirium diagnosis; guideline-adherence) from clinical records. Clinical record data (evidence of: delirium using a validated chart-based instrument; guideline-adherent delirium care) was collected from 50 consecutive in-patient admissions at three hospices pre- and post-implementation of a co-designed implementation strategy (data collection completed 3 December 2022). Analysis: Pre-post comparison of percentages for continuous data (delirium outcomes); nominal data (raw count of guideline-adherent metrics).

Results Target clinical record data collection (n=300) was achieved within timeframe, despite data collection during COVID-19. Delirium prevalence was comparable pre-and post-implementation with two-thirds of patients having a delirium episode during admission. There was a reduction in the proportion of delirium-days during admission 62% to 49%. We observed modest post-implementation improvements in most guideline-adherent metrics: delirium diagnosis as documented by the clinical team 15% to 26%; evidence of reversibility 33% to 36%; delirium risk assessment 0% to 12.5%; screening on admission 21% to 35%.

Conclusion Data collection about delirium outcomes and guideline-adherence from hospice clinical records is feasible. Our findings show the disparity between need (high delirium-incidence) and documented action (low guideline-adherence). However, there is a signal of patient benefit even with small documented improvements which needs to be formally evaluated in a multi-site study of effectiveness of an implementation strategy for improving delirium guideline-adherence.

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